title: Osseous sarcoidosis treated with tumor necrosis factor-inhibitors: case report and review of the literature.
abstract: METHODS
  Report of 2 cases of sarcoidosis involving vertebrae successfully treated with tumor necrosis factor-α inhibitor (TNF-α antagonist).
  
  
  OBJECTIVE
  To disseminate knowledge concerning successful treatment of sarcoidosis involving the axial skeleton with the use of TNF-α blockers.
  
  
  BACKGROUND
  Osseous sarcoidosis most commonly involves small bones of hands and feet; vertebral involvement is rare, and currently there is no consensus on optimal treatment.
  
  
  METHODS
  Two cases are described detailing patients with extrapulmonary sarcoidosis involving vertebral bodies, retractable to conventional treatment, who were treated with TNF-α antagonists.
  
  
  RESULTS
  We observed a remarkable response following the administration of TNF-α blockers in vertebral sarcoidosis with marked resolution of lytic lesions. The patients remained asymptomatic with no recurrence of their disease.
  
  
  CONCLUSIONS
  Vertebral sarcoidosis is a rare manifestation of osseous sarcoidosis. Symptomatic patients are treated with various immunosuppressive therapies. We propose utilizing TNF-α blocking agents in patients who fail to respond to first-line therapy.
authors.affiliation: Stony Brook University Medical Center, Stony Brook, NY 11794, USA. sarfarazhasni@hotmail.com
authors.forename: Sarfaraz A
authors.initials: SA
authors.lastname: Hasni
authors.forename: Daniel
authors.initials: D
authors.lastname: Kunz
authors.forename: Kathleen
authors.initials: K
authors.lastname: Finzel
authors.forename: Barry L
authors.initials: BL
authors.lastname: Gruber
mesh_terms: D000068879:Adalimumab; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage; D005260:Female; D006801:Humans; D000069285:Infliximab; D008875:Middle Aged; D011859:Radiography; D012507:Sarcoidosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D013122:Spinal Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D013131:Spine / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000473:pathology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000276:immunology*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab